The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Patulous Eustachian Tube Causing Hypermobile Eardrums
A
20-year-old man presented with a 6-year history of popping Chao-Yin Kuo, M.D. sounds in both ears when he breathed deeply. Aural fullness and autophony Chih-Hung Wang, M.D., Ph.D. of the voice and breathing sounds were also described. Pure-tone audiometry Tri-Service General Hospital showed normal hearing. Otoscopy showed indrawn and severely atrophic eardrums Taipei, Taiwan that moved outward on regular nasal expiration and inward on regular nasal inspi- [email protected] ration. The inflation and collapse of each hypermobile eardrum was marked on forced nasal breathing (Figure and Video). We diagnosed patulous eustachian tubes, which involve abnormal patency of the eustachian tubes that readily permits the flow of air to and from the nasopharynx into the cleft of the middle ear. Risk factors for patulous eustachian tubes may include rapid weight loss, mucosal atrophy or scarring, muscular dysfunction, and high estrogen levels. The patient reported having recurrent otitis media since childhood, which prompted myringotomy on three occasions. After presentation, he underwent myringotomy with grommet insertion and had complete resolution of symptoms. There was no significant difference in hearing level after the procedure, and he remained asymptomatic at follow-up 10 months after treatment.
DOI: 10.1056/NEJMicm1403262 Copyright © 2014 Massachusetts Medical Society.
n engl j med 371;25
nejm.org
december 18, 2014
The New England Journal of Medicine Downloaded from nejm.org on October 17, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
e37
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Patulous Eustachian Tube Causing Hypermobile Eardrums
A
20-year-old man presented with a 6-year history of popping Chao-Yin Kuo, M.D. sounds in both ears when he breathed deeply. Aural fullness and autophony Chih-Hung Wang, M.D., Ph.D. of the voice and breathing sounds were also described. Pure-tone audiometry Tri-Service General Hospital showed normal hearing. Otoscopy showed indrawn and severely atrophic eardrums Taipei, Taiwan that moved outward on regular nasal expiration and inward on regular nasal inspi- [email protected] ration. The inflation and collapse of each hypermobile eardrum was marked on forced nasal breathing (Figure and Video). We diagnosed patulous eustachian tubes, which involve abnormal patency of the eustachian tubes that readily permits the flow of air to and from the nasopharynx into the cleft of the middle ear. Risk factors for patulous eustachian tubes may include rapid weight loss, mucosal atrophy or scarring, muscular dysfunction, and high estrogen levels. The patient reported having recurrent otitis media since childhood, which prompted myringotomy on three occasions. After presentation, he underwent myringotomy with grommet insertion and had complete resolution of symptoms. There was no significant difference in hearing level after the procedure, and he remained asymptomatic at follow-up 10 months after treatment.
DOI: 10.1056/NEJMicm1403262 Copyright © 2014 Massachusetts Medical Society.
n engl j med 371;25
nejm.org
december 18, 2014
The New England Journal of Medicine Downloaded from nejm.org on October 17, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
e37
